Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth
MassHealth
All Provider Bulletin 219a
November 2011
TO: All Providers Participating in MassHealth
FROM: Julian J. Harris, M.D., Medicaid Director
RE: 5010 Implementation Readiness - Corrected
Background
The Centers for Medicare & Medicaid Services (CMS) has mandated that on
January 1, 2012, the standards for electronic health care transactions must
change from version 4010/4010A1 to version 5010. MassHealth is actively
working toward this January 1, 2012, implementation date. All electronic health
care transactions currently submitted to, or returned from, MassHealth in the
4010A1 version are affected. Please refer to All Provider Bulletin 205 for a
list of the affected transactions.
Are you Ready to Implement 5010?
Over the past year, MassHealth has conducted a series of provider information
sessions, issued provider bulletins, updated job aids, and communicated with
you through provider associations and other standard MassHealth media to
inform you of the impending 5010 January 1, 2012, implementation date.
Additionally, MassHealth has updated the HIPAA companion guides, billing
guides, and other relevant instructions (for example, third-party liability
(TPL)instructions). MassHealth has also provided a number of key educational
materials required to prepare you for the transition to the new HIPAA standard.
Please consider the following questions to determine if you are ready for the
January 1, 2012, implementation date
* Have you completed trading partner testing with MassHealth?
If you have not completed trading partner testing, do not wait. Contact
MassHealth immediately at 1-855 253 7717 or at edi@mahealth.net to
arrange for testing.
* Have you validated that your software vendor or billing intermediary
has been approved to submit 5010 transactions to MassHealth by
contacting your vendor directly or confirming their testing status at
www.mass.gov/masshealth/5010?
If your vendor is not approved, or is not actively testing with MassHealth,
please contact them to confirm that they will be ready to support your
organization on January 1, 2012.
(continued on next page)
Are you Ready to Implement 5010? (cont)
* Have you modified your internal practice management systems,
trained staff, and updated affected policies and procedures as
required?
If not, please do so immediately to ensure that your organization is ready
to operationally support 5010 implementation.
* Have you identified a contingency plan in case your organization is
not ready by January 1, 2012?
Please Note: When defining your contingency plan, remember that
MassHealth is eliminating paper claims submissions, except in certain
circumstances, as of January 1, 2012. Refer to All Provider Bulletin 217 for
further details. As previously noted, MassHealth will not process any 4010
claims after the cutover to the 5010 mandate effective January 1, 2012.
If you can answer yes to all of these questions, your organization should be
ready for a successful implementation.
Trading Partner Testing Timelines
MassHealth began the trading partner testing phase with trading partners
on October 3, 2011. This testing phase will end on December 23, 2011. This means that all trading partners must successfully test with MassHealth by that date to ensure that they can submit 5010 transactions in production on January 1, 2012. In order to ensure that all transactions are tested before implementation in a timely and efficient manner, MassHealth has developed the following implementation testing timeline.
Date
First/Last Days of Testing Activity
08/16/2011
This was the first day that MassHealth began testing with software
vendors and billing Intermediary trading partners.
10/03/2011
This was the first day that MassHealth began testing with all other
trading partners.
11/23/2011
This is the last day that MassHealth will accept an initial test file from any
trading partner.
12/12/2011
This is the last day that MassHealth will accept any 5010 HIPAA test file
from any trading partner before implementation.
12/23/2011
This is the last day that MassHealth will approve a test file for 5010.
01/03/2011
Trading partner testing resumes.
It is imperative that you adhere to these testing timelines. If you do not
submit your test files in accordance with the above testing timeline, there is no guarantee that you will be approved in time to submit production files to
MassHealth on January 1, 2012. Additionally, if you do not complete trading
partner testing before the deadline, it may affect your cash flow as MassHealth
will not accept any 4010 transactions after it cuts over to 5010 transaction
processing on January 1, 2012.
(continued on next page)
MCO Testing Timelines
MassHealth has completed internal testing of the 5010 820 transaction set and
is currently in the second cycle of user acceptance testing (UAT) with the
managed care entities. We are continuing with internal testing of the 5010 834
transaction set and are currently in beta testing with one managed care entity.
The 5010 cutover plans are still in the planning stage and, once the dates are
finalized, they will be communicated to the managed care entities through the
5010 biweekly meetings.
4010 Transactions
Currently, MassHealth conducts trading partner testing for 4010 HIPAA batch
transactions in production with new and existing providers. In order to prepare
for the upcoming transition to 5010, and the natural decline in requests to
convert to 4010 transaction processing, MassHealth will stop 4010 trading
partner testing according to the following schedule.
Date
Last Day of Activity
11/23/11
This is the last day that MassHealth will accept a 4010 test file for
evaluation.
11/30/11
This is the last day that MassHealth will approve a 4010 test file.
If you are currently planning to convert to 4010 transaction processing, please
ensure that you meet the deadlines noted above. MassHealth recommends
that trading partners consider the timeline of the 5010 implementation testing
and any efforts that would need to be expended to support 4010 production
testing before requesting to convert to 4010.
5010 Cutover
MassHealth will begin to transition its 4010 transaction processing to 5010 in
late December 2011. In preparation for this transition, MassHealth will outline
when it will officially switch to the 5010 transaction processing. This will
include, but not be limited to, the last day that MassHealth will execute a 4010
transaction in the production environment. The cutover schedule will be
communicated in a future all-provider bulletin before the implementation.
EVS PC Software Update
MassHealth has updated the Eligibility Verification System PC (EVSpc)
software to include HIPAA 5010 requirements for eligibility and claim status
inquiries and responses. The EVSpc reports have also been enhanced to
accommodate various field-length changes. On December 12, 2011, the
EVSpc software and installation instructions will be available to providers for
download at www.mass.gov/masshealth/5010.
(continued on next page)
EVS PC Software Upate (cont.)
To ensure that you can submit 5010 inquires in January, please ensure
that you download the product and install the new software before January 1, 2012.
Important: Once you download the new 5010 software, it will override your
current 4010 software. This means that you will not be able to send any 4010
transactions to MassHealth. If you plan to download the software before January
1, 2012, MassHealth recommends that you do one of the following:
* download the new software on a separate computer to ensure that your 4010
data is not erased; or
* download the new software only when you are ready to submit 5010 inquiries
to MassHealth.
The existing 4010 EVSpc software will not work after the 5010 implementation
date, as MassHealth will not support dual transactions with 5010 implementation.
If you have specific questions about this process, please e-mail your request to
edi@mahealth.net.
Eligibility Verification
EVSpc software installation is supported only on Windows XP and Windows
Vista. MassHealth strongly discourages providers from using Windows 7 to run
EVSpc software. EVSpc software may not function correctly on Windows 7, and
MassHealth cannot provide technical support for the product when used with the
Windows 7 operating system.
A list of the key changes that have been made to the EVSpc software to support
the 5010 mandate is listed in the table below.
Key Changes
Eligibility Inquiry and Responses
Key Changes
Claim Status Inquiry and Response
The number of characters for the following name
fields has been increased.
* Name field for Provider Organization, TPL
Carrier, Managed Care, Behavioral Health,
and Long Term Care
* Name field for member first and last name
* Patient account number
* Tracking number
The Member day,night, and cell phone number
has been removed from the Member Information
tab of the Eligibility response screen.
The number of characters for the following fields
has been increased:
* Member first and last name; and
* Control and patient account number fields.
The member gender value “Unknown” was
removed from the dropdown box and member
gender.
The date of birth was removed from the claim
detail response screen.
A claim reference identifier has been added to
the claim status inquiry and response screen.
A new line item control number has been added
to the claim status response screen.
(continued on next page)
Important Reminders
Paper Reduction
As of January 1, 2012, MassHealth will require all claims to be submitted in an
electronic format, unless the provider has received an approved electronic claim
submission waiver. If you currently have difficulty submitting claims
electronically, and meet the criteria for a waiver as outlined in All Provider
Bulletin 217, dated September 2011, please be sure to submit your request for a
waiver beginning in November 2011, to ensure that you have the necessary
approvals in place before January 1, 2012.
Coordination of Benefits (COB)
In accordance with the paper reduction initiative described in All Provider
Bulletin 217, it is imperative that you convert to electronic claim submission
before January 1, 2012. You may use any of the following electronic options to
submit COB claims to MassHealth.
* 837P and 837I COB
* direct data entry (DDE) of COB through the Provider Online Service Center
(POSC)
Do not delay. If you have not yet converted to any of the electronic options
noted above, please contact MassHealth immediately to discuss your billing
transition.
For DDE, call 1-800-841-2900. For batch transaction processing, contact the EDI
team at edi@mahealth.net.
Training
In order to effectively support the transition from paper claims to electronic
claims, MassHealth has scheduled a number of POSC DDE training sessions
between October 2011 and January 2012. MassHealth encourages you to sign
up for the DDE training sessions to ensure that you and your staff are trained
and prepared to submit claims via DDE in January 2012.
Schedule your training session today by going to www.mass.gov/masshealth and
clicking on Provider Training to view the schedule and register. You can also
register by contacting MassHealth Customer Service at 1-800-841-2900.
Please visit the 5010 Web page at www.mass.gov/masshealth/5010 to view the
POSC DDE job aid, along with other 5010-related job aids and preparation
documents.
Questions
If you have any questions about the information in this bulletin, please contact
MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to
providersupport@mahealth.net, or fax your inquiry to 617-988-8974.